EM Coding Alert

Answer: You won’t need a modifier but you need to consult with your payers on whether they allow you to bill the HRA service separate from the E/M. For instance, Blue Cross Blue Shield of North Carolina does not consider a health risk assessment instrument (99420, Administration and interpretation of health risk assessment instrument [eg, health hazard appraisal]) separately reimbursable, but rather incidental to the associated evaluation and management services. In fact, the information gleaned from the HRA can be used toward the history components of the E/M service and possibly in some of the decision-making.

 

For more information, refer to www.bcbsnc.com/content/providers/news-and-information/news/NoticeOfMedPolicyRevision_CPT99420.htm.

For documentation purposes, save the HRA in the patient’s chart. You also need to clearly illustrate the discussion about the assessment in the patient’s record.

 

Background: According to the CDC, “As part of the annual wellness visit, an health risk assessment (HRA) may be completed before, or as part of, a visit with a health professional who may be a physician, physician’s assistant, nurse practitioner, or clinical nurse specialist, or a team of such medical professionals working under the direction supervision of a physician.”

 

The law specifies that the HRA guidelines will be developed to provide that HRAs:

 

1. Identify chronic diseases, injury risks, modifiable risk factors, and urgent health needs of an individual

2. May be furnished through an interactive telephonic or web-based program

3. May be offered during the encounter with a healthcare professional or through community-based prevention programs

4. May be provided through any other means the secretary determines appropriate to maximize accessibility and ease of use by beneficiaries, while ensuring the privacy of beneficiaries.